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  • No MD Degree Needed for Eye Surgery — What Happened in Kentucky?

    Within just days, organized optometry in Kentucky was able to push a bill through the state legislature and have it signed into law by the state governor on Feb. 24. The new law allows Kentucky optometrists to do:

    • Laser procedures, including laser trabeculoplasties, iridoplasties, peripheral iridotomies, YAG capsulotomies, LASEK and laser “only” clear-lens extraction.
    • Incisional surgery (“scalpel procedures”), with some exceptions.
    • Intraocular injections (except the “posterior chamber”), technically allowing injections into the vitreous or posterior segment.
    • All methods of administering pharmaceutical agents, including injection procedures, except Schedule I and II drugs.
    • Local and regional anesthesia.

    It also allows an independent optometric board to determine its own scope of practice. According to the bill:

    "(6) Nothing in this chapter shall be construed as allowing any agency, board, or other entity of this state other than the Kentucky Board of Optometric Examiners to determine what constitutes the practice of optometry.
    (7) The board shall have the sole authority to determine what constitutes the practice of optometry and sole jurisdiction to exercise any other powers and duties under this chapter."

    The bill was detected by the Kentucky Medical Association (KMA) and the Kentucky Academy of Eye Physicians and Surgeons (KAEPS) a mere 16 hours before the first committee hearing on the bill.

    As the Louisville Courier-Journal noted: “Optometrists greased the legislative machinery with campaign contributions to all but one legislator (a physician), totaling at least $327,650 in the last two years, plus $74,000 to [Kentucky Gov. Steve] Beshear's re-election campaign. And if employees and spouses of optometrists were added, the total would probably be significantly more.

    “The battle in Frankfort was almost over before it began.”

    As Academy EVP/CEO David W. Parke II, MD, remarked recently, “Medicine had tremendous support from both departments of ophthalmology in Lexington and Louisville, from the leadership of those universities, from the state osteopathic association and the college of osteopathic medicine. Key national ophthalmology subspecialty societies weighed in promptly with letters from their leaderships. The optometric bill was opposed by virtually every major state newspaper and by the Kentucky Hospital Association.

    “At the end of the day, quality of care, patient safety and sound policy were trumped by money and local politics.”

    What Do Kentucky Citizens Think?

    Organized optometry has claimed that, in rural areas of the state, there is more access to optometrists than ophthalmologists — a justification for the law’s provisions. Yet, as noted by Kentucky’s Commonwealth Network on Channel 2, a poll after the law’s passage showed that:

    “79 percent of respondents said any surgery should be performed by ophthalmologists … [and] showed the most opposition to optometrists performing surgeries came in the most rural areas. In the First Congressional District covering western and southern Kentucky, nearly 87 percent said surgeries should be performed by an ophthalmologist and nearly 84 percent said that in the Fifth Congressional District in eastern Kentucky.”

    Is Your State Next?

    To date, the Academy and state ophthalmology societies have succeeded in protecting patients by keeping surgery in appropriately trained hands, in 25 states — half the United States. But optometry-supported surgery bills are currently pending in several states:Alabama — Injection procedures, scalpel surgery

    • Colorado — A “sunset review” bill, introduced with vague surgery language
    • Nebraska — Laser surgery, injection procedures, scalpel surgery
    • South Carolina — Eyelid surgery
    • Texas — Laser surgery, injection procedures, scalpel surgery
    • West Virginia — Injection procedures

    What You Can Do

    It’s a medical reality — political engagement by MDs is the only way to ensure patient surgical eye safety and quality of care.   

    The first step is to join your state society. As a member, you help fund their continued work, protecting your patients and profession in your state.

    If you are already a state-society member, consider giving money to your society’s political action committee (PAC). PAC contributions go straight to advocacy work, whereas membership dues often need to be split to fund different parts of the society.

    You can also opt to give to the Academy’s Surgical Scope Fund, which allows you to help state societies throughout the entire country. And when you donate to OPHTHPAC, you help support election campaigns for candidates who are sensitive to ophthalmology patients and issues.

    And your donations truly do make a difference. An example of membership dues and PAC money at work: in California, we had recent legislation that was very similar to the Kentucky bill. But thanks to the response of the California Academy of Eye Physicians and Surgeons (CAEPS), this was watered down to glaucoma “certification” — and even this is now tied up in the courts.

    The local Medicare carrier also recently wanted additional documentation for doing cataract surgery on a 20/50 or better cataract, which would have almost set a “cut-off.” When CAEPS vigorously opposed this, the carrier adopted CAEPS’ rewrite.

    Another key to political engagement is to establish a personal relationship with a legislator from your state and/or district. Trust me, they do want to hear your voice! I have found them to be very receptive to Eye M.D.s (especially YOs).

    Consider attending the Academy’s Mid-Year Forum in Washington, D.C., next month: April 6 to 9. During Congressional Advocacy Day, you can meet with your congressional representatives and staff directly in the nation’s capitol. Advance registration for both events has closed, but onsite registration begins at 4 p.m. April 6.

    You might feel that your involvement won’t really make a difference, but it does. Medical associations are truly the only ones looking out for MDs, and they’re working hard to preserve our profession. They need funding, and they need manpower. By joining your state society, you are making an investment in the future of both your patients and the profession.

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    About the author: Diana R. Shiba, MD, is in her second year of practice at Kaiser in the Los Angeles area, and is a member of the Academy’s YO Subcommittee on Advocacy and the CAEPS Board of Councilors.